UKMLA AKT Guideline Refresh — May 2026: Type 2 Diabetes, Cancer Referral, Menopause
Six confirmed NICE refreshes (NG28, QS209, NG12, CG122, QS18, NG23) already patched across the bank. The four sequence changes that move marks on UKMLA AKT Paper 1 / Paper 2 stems — and how to drill them in a week.
What changed
- NG28 Type 2 diabetes (last reviewed 18 Feb 2026): NICE re-reviewed the evidence on T2D medicines and made / updated recommendations for two patient groups — adults with no relevant comorbidities, and adults with common comorbidities. Insulin recommendations were also reworked in the context of insulin product withdrawals and known brand shortages.
- QS209 Type 2 diabetes quality standard (18 Feb 2026): Quality statement 5 on SGLT-2 inhibitor treatment was updated to include all adults with T2D, widening it from the previous cardiovascular- and heart-failure-gated population to a default consideration in routine T2D management.
- NG12 Suspected cancer: recognition and referral (last reviewed 15 Apr 2026): new and updated recommendations on ovarian cancer age and serum CA125 thresholds (recs 1.5.6 to 1.5.9, and 1.5.11), updated endometrial cancer recommendations (1.5.12, 1.5.14, 1.5.15), and a new non-site-specific weight-loss recommendation (1.13.2).
- CG122 Ovarian cancer: recognition and initial management (15 Apr 2026): the recommendations on detecting ovarian cancer in primary care (section 1.1) were removed entirely — those decisions now sit inside NG12 with the new CA125 thresholds, so revision must use NG12 (not CG122) as the source of truth for the primary-care decision.
- QS18 Ovarian cancer quality standard (15 Apr 2026): updated alongside NG12, including the placeholder statement (statement 2) prioritised in 2025.
- NG23 Menopause: identification and management (last reviewed 15 Apr 2026): amended advice on when to seek help for vaginal bleeding while taking systemic HRT, in the starting-HRT section.
Why it matters for your score
- These aren't wording changes — they're sequence changes. The first-line decision, the threshold for referral, and the escalation step have moved. Year-old recall on diabetes management or cancer referral now produces a wrong answer on a current stem.
- The QS209 SGLT-2i extension is the single highest-yield diabetes change for UKMLA AKT and PLAB 1 stems. It moves SGLT-2i from a cardiovascular- or HF-gated decision to a default consideration in routine T2D management — and AKT-style 'best next step' questions are designed to test exactly that distinction.
- Cancer-referral stems are a perennial trap on both papers. The new CA125 + age thresholds and the endometrial recommendations change which option is 'the correct next step in primary care' on common postmenopausal-bleeding and abdominal-bloating presentations.
- The CG122 → NG12 reshuffle means a candidate revising from older notes (or older question explanations) will pick the wrong document for ovarian-cancer detection logic. NG12 is now the only source of truth for the primary-care decision; CG122 starts at secondary-care diagnosis.
- Vaginal-bleeding-on-HRT stems are short, common, and decisive — outdated escalation advice cleanly maps to a wrong 'best next action'. NG23's amendment is small in word count but disproportionate in mark impact.
Common questions
When did the May 2026 NICE refresh actually take effect — and which sittings does it affect?
Two cluster dates: the type 2 diabetes group (NG28 + QS209) was re-reviewed on 18 February 2026; the cancer-referral group (NG12 + CG122 + QS18) and the menopause guideline (NG23) were re-reviewed on 15 April 2026. Any UKMLA AKT or PLAB 1 sitting from late Q1 2026 onward is fair game for the diabetes changes; mid-2026 sittings will fully reflect every change in this article.
Are these changes already in the MedRevisions question bank?
Yes — every affected MCQ explanation and condition note was patched in lockstep with each NICE update going live. You can verify by looking at the 'last reviewed' date on any nephrology, diabetes, cancer-referral, or menopause note: anything dated Feb or April 2026 has been touched by this refresh. Wrong-answer corrections also flag when a stem's correct answer flipped because of a guideline change since your previous attempt.
Did NG28 actually change diabetes management, or just the wording?
It changed the recommendation logic for type 2 diabetes in two patient groups — adults with no relevant comorbidities, and adults with common comorbidities — and reworked insulin recommendations because of product withdrawals and known brand shortages. Practical decisions on drug class and escalation order have moved; this is not a wording refresh.
What's the SGLT-2 inhibitor change in QS209?
Quality statement 5 used to gate SGLT-2 inhibitor treatment on cardiovascular or heart-failure indications. The February 2026 update extends it to include all adults with type 2 diabetes, raising it from a 'selected patient' decision to a default consideration in routine T2D management. This is the single most exam-tested diabetes change for UKMLA AKT and PLAB 1 in 2026.
Why is the ovarian cancer guideline (CG122) shorter now?
Section 1.1 (detecting ovarian cancer in primary care) was removed entirely from CG122 in April 2026. Those decisions now sit inside NG12 with new age-banded CA125 thresholds. If a stem asks about a primary-care decision and you reach for CG122 first, you'll miss the actual logic — the source of truth for the primary-care ovarian-cancer decision is now NG12.
Did NG12 actually change endometrial cancer referral?
Yes — recommendations 1.5.12, 1.5.14, and 1.5.15 were updated alongside the ovarian recommendations on 15 April 2026. Stems on postmenopausal bleeding, ultrasound thresholds, and the timing of urgent referral now have updated correct answers. There is also a new non-site-specific weight-loss recommendation (1.13.2) for adults presenting with unexplained weight loss.
What's the menopause / HRT change in NG23?
The starting-HRT section now carries amended advice on when to seek help for vaginal bleeding while taking systemic HRT. It's small in word count but disproportionately high-yield: a one-liner on a stem can flip the right escalation answer, and these stems are short and common on both UKMLA AKT and PLAB 1.
How do I revise a six-guideline refresh without spending two weeks on it?
Prioritise the four highest-yield clusters in this order: SGLT-2i in T2D (QS209), cancer-referral thresholds (NG12 ovarian + endometrial), HRT bleeding escalation (NG23), and the insulin-shortage prescribing decision (NG28). One focused 20-question block per cluster plus one timed mixed mock will close roughly 80% of the score impact in under a week.
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